TOWNSHIP OF FREEHOLD

1 MUNICIPAL PLAZA
FREEHOLD, NJ 07728

REQUEST FOR ACCESS TO GOVERNMENT RECORDS

------------------------------------------------------------------------------FOR MUNICIPAL USE ONLY

Date Received:_____________________________ Date of Response:________________________________

-------------------------------------------------------------------------------Name:

___________________________________________________________________________

Address:

___________________________________________________________________________

Telephone (Day) ______________________________________________________________________

Information Requested:
_______

Copy of Minutes (specify board of entity, date, topic or other identifying information)
________________________________________________________________________

_______

Copy of Ordinance/Resolution (specify date, number or other identifying information)

________________________________________________________________________

_______

Other (specify) __________________________________________________________

________________________________________________________________________

__________________________________________________________________
_______

Information on a Specific Property Address _____________________________

Block _______________

Lot _____________________

Applicant ________________________________ Date _____________________________

Municipal Official _________________________ Date _____________________________

PAGE 2 - ACCESS

FOR FREEHOLD TOWNSHIP USE ONLY

Request forwarded to: (Department/s)

________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Received by: Signature & Date _______________________________________

__________________________________________

Records Provided by: Department/Signature __________________________________

____________________________________________________________________________

DATE:
___________________________________________________________________

Freehold Township Clerk's Office

PUBLIC RECORDS REQUEST RESPONSE
TO:
Document(s) provided:

pages at total cost of:

Document(s) not provided (see below)

The document or documents listed below and requested by you are not being provided because the document or
documents are not public records as provided by law, as noted below:

Privileged or Protected Category

Authority
Autopsy Reports
Child abuse or sex assault victim name or address
Court records sealed
Computer security information
Criminal investigatory records
Credit Card Numbers
Grand Jury testimony, information
Grievance information with public employer
Domestic Violence data
Drivers license numbers
DYFS information
Electronic Surveillance Materials
Emergency or security information or procedures
Employee sexual harassment complaints
Fingerprint cards
Inter-agency or intra-agency advisory communications
Juvenile records
Labor Negotiation information, strategy or positions
Medical Examiner Photographs
Otherwise inappropriate material
Pension and personnel records
Photographs
69
Pre-Sentence Investigations
Div. 1971)
Public Agency insurance communications
Safety of persons or public
69
Security measures and surveillance techniques
Social Security Numbers
Unlisted Telephone Numbers
Victim locations (Domestic Violence)
Victim records
Record has been destroyed/not retained pursuant to:
Other

N.J.S.A. 47:1A-1.1, et seq.

N.J.S.A. 2A:82-46b
Executive Order 69
N.J.S.A. 47:1A-1.1, et seq.
N.J.S.A. 47:1A-1.1, et seq.
N.J.S.A. 47:1A-1.1, et seq.
Court Rule 3:6-7
N.J.S.A. 47:1A-1.1, et seq.
N.J.S.A. 2C:25-33
N.J.S.A. 47:1A-1.1, et seq.
N.J.S.A. 9:6-8.10
N.J.S.A. 2A:156A-19
N.J.S.A. 47:1A-1.1, et seq.
N.J.S.A. 47:1A-1.1, et seq.
Executive Order 69
N.J.S.A. 47:1A-1.1, et seq.
N.J.S.A. 2A:4A-60
N.J.S.A. 47:1A-1.1, et seq.
N.J.S.A. 47:1A-1.1, et seq.
Executive Order 69
N.J.S.A. 47:1A-1.1, et seq.
N.J.S.A. 47:1A-1.1, et seq.; Executive Order
State v. DeGeorge, 113 NJ Super.542 (App.
N.J.S.A. 47:1A-1.1, et seq.
N.J.S.A. 47:1A-1.1, et seq.; Executive Order
N.J.S.A. 47:1A-1.1, et seq.
N.J.S.A. 47:1A-1.1, et seq.
N.J.S.A. 47:1A-1.1, et seq.
N.J.S.A. 2C:25-26c
N.J.S.A. 47:1A-1.1, et seq.
Records Retention and Disposition Schedule
(NJ Dept. of State, Div. of Archives Mgmt.)

You have a right to appeal the decision that the document or documents are not public records. You may take your
appeal to the Public Records Council or to the New Jersey Superior Court, as provided by N.J.S.A. 47:1A-6 and 7.
Date:
Freehold Township Clerk's Office

ACKNOWLEDGMENT
I hereby acknowledge that I have received the documents requested except for any documents specifically listed
above on which a determination has been made that the documents will not be provided. If any documents have not
been provided, I have received information on this form as to the procedures for any appeal of the determination.
Date:
Applicants Signature

Freehold Township Clerk's office

Information/Record Request Form
Requestor Information
Name:
Address:
Telephone Number: (

Signature:

Date of Request:

Description of Record(s) Requested:

Request Forwarded to: (Department/s) _________________________________________

_________________________________________________________________________

Date Received By: Signature/Department/s ______________________________________

______________________________________

Unable to provide requested material

Request Denied

Reason:

Date record(s) available:

Records provided by Department/Signature : ____________________
Date: ___________________

Deposit required where anticipated cost of reproduction exceeds $5.00 _____________________

All checks payable to the Township of Freehold